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A Major Depressive Disorder in a Patient with Pseudobulbar Affect

Pseudobulbar affect is a condition that presents as involuntary laughing or crying among patients with certain neurological conditions or injuries. There is an outburst of crying or laughing that may not be connected to the current emotional state. Because pseudobulbar affect often involves crying,...

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Autores principales: Espiridion, Eduardo D, Risos, Kyle N
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6388818/
https://www.ncbi.nlm.nih.gov/pubmed/30820367
http://dx.doi.org/10.7759/cureus.3746
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author Espiridion, Eduardo D
Risos, Kyle N
author_facet Espiridion, Eduardo D
Risos, Kyle N
author_sort Espiridion, Eduardo D
collection PubMed
description Pseudobulbar affect is a condition that presents as involuntary laughing or crying among patients with certain neurological conditions or injuries. There is an outburst of crying or laughing that may not be connected to the current emotional state. Because pseudobulbar affect often involves crying, the condition is frequently mistaken for depression. We present the case report of a 54-year-old male patient who had a stroke and who presented to his physician with a chief complaint of crying spells. His family expressed, and his physician believed, that he was suffering from depression because of his dramatic clinical presentation. The patient initially denied that he was depressed. Despite the denial, he was managed with psychotherapy and an antidepressant medication, Remeron (mirtazapine). The treatment did not improve his clinical symptoms. He was eventually treated with dextromethorphan/quinidine (DM/Q), 20 mg/10 mg, with a dramatic resolution of the crying spells.  However, psychosocial stressors, including the death of his father, job loss, and financial problems, made him depressed with vegetative symptoms. His crying spells came back and became more intense and frequent. He became worthless and hopeless. This depression was unrelated to his stroke. He was diagnosed with a major depressive disorder and was treated with antidepressants and psychotherapy. He experienced the depression several months after his crying spells resolved with the DM/Q. His recent bout of depression was treated with another antidepressant, vilazodone, and he was given a more intensive outpatient psychotherapy treatment. All the psychiatric symptoms, including the crying spells, have improved after treatment.  
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spelling pubmed-63888182019-02-28 A Major Depressive Disorder in a Patient with Pseudobulbar Affect Espiridion, Eduardo D Risos, Kyle N Cureus Psychiatry Pseudobulbar affect is a condition that presents as involuntary laughing or crying among patients with certain neurological conditions or injuries. There is an outburst of crying or laughing that may not be connected to the current emotional state. Because pseudobulbar affect often involves crying, the condition is frequently mistaken for depression. We present the case report of a 54-year-old male patient who had a stroke and who presented to his physician with a chief complaint of crying spells. His family expressed, and his physician believed, that he was suffering from depression because of his dramatic clinical presentation. The patient initially denied that he was depressed. Despite the denial, he was managed with psychotherapy and an antidepressant medication, Remeron (mirtazapine). The treatment did not improve his clinical symptoms. He was eventually treated with dextromethorphan/quinidine (DM/Q), 20 mg/10 mg, with a dramatic resolution of the crying spells.  However, psychosocial stressors, including the death of his father, job loss, and financial problems, made him depressed with vegetative symptoms. His crying spells came back and became more intense and frequent. He became worthless and hopeless. This depression was unrelated to his stroke. He was diagnosed with a major depressive disorder and was treated with antidepressants and psychotherapy. He experienced the depression several months after his crying spells resolved with the DM/Q. His recent bout of depression was treated with another antidepressant, vilazodone, and he was given a more intensive outpatient psychotherapy treatment. All the psychiatric symptoms, including the crying spells, have improved after treatment.   Cureus 2018-12-18 /pmc/articles/PMC6388818/ /pubmed/30820367 http://dx.doi.org/10.7759/cureus.3746 Text en Copyright © 2018, Espiridion et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Psychiatry
Espiridion, Eduardo D
Risos, Kyle N
A Major Depressive Disorder in a Patient with Pseudobulbar Affect
title A Major Depressive Disorder in a Patient with Pseudobulbar Affect
title_full A Major Depressive Disorder in a Patient with Pseudobulbar Affect
title_fullStr A Major Depressive Disorder in a Patient with Pseudobulbar Affect
title_full_unstemmed A Major Depressive Disorder in a Patient with Pseudobulbar Affect
title_short A Major Depressive Disorder in a Patient with Pseudobulbar Affect
title_sort major depressive disorder in a patient with pseudobulbar affect
topic Psychiatry
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6388818/
https://www.ncbi.nlm.nih.gov/pubmed/30820367
http://dx.doi.org/10.7759/cureus.3746
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